HOW WE CAN HELP.

Our SPORTS THERAPY C.A.i.R.E. Team believes in a multifaceted approach and that no single test should be used in isolation.

Neurocognitive Performance (imPACT Baseline Computer Test)

Vestibular Balance and Postural Sway

Visual Coordination and Occulomotor reflex

We carefully review and document previous concussive episodes and history of concussion-like symptoms to aid in development of individualized post-injury assessment and treatment protocols.

Baseline values can vary widely and in young developing athletes, these measures can change dramatically from year to year. It is important to record baseline values of physical and neurocognitive function before the start of each sports season. Should an athlete sustain a concussion during the season, C.A.i.R.E. practitioners have the ability to compare post-injury testing to baseline values. This allows for a more accurate and objective assessment and provides important information when making return-to-play decisions.

imPACT TESTING INFORMATION.

Recent advancements in concussion management have resulted in the widespread use of computer-based neurocognitive testing protocols, and evidence now shows that concussed athletes demonstrate subtle cognitive deficits that may persist beyond symptom resolution – emphasizing the fact that return to play once “symptom-free” is no longer an accurate measure of readiness. impact Baseline Testing is available at SPORTS THERAPY C.A.i.R.E. Computerized neurocognitive testing is part of all baseline and post-injury assessment protocols. This type of testing provides us with a snapshot of how an athlete’s brain is functioning both pre and post injury by measuring things like reaction time, processing speed, memory, and attention/concentration. These cognitive processes are often affected by concussive injury, therefore testing provides us with important information when managing an athlete’s recovery. Note: computer-based neurocognitive tests designed for concussion assessment (eg. ImPACT) are invaluable tools that provide objective information on various aspects of neurocognitive performance; however these tests are not meant to replace a full neuropsychological assessment that would be provided by a qualified Neuropsychologist. When further comprehensive testing is required, a specialist referral may be indicated.

POST-INJURY THERAPY.

Have you sustained a Concussion? Consult a Medical Physician or Sports Doctor as soon as possible for a medical evaluation. Contact a SHIFT Concussion Certified Practitioner 905.848.3010 Most concussion injuries do not require emergency care. However, It is important that the athlete remain under close observation.

See our FAQ's for a full list of concussion signs and symptoms.

When to go to the hospital.

Emergency evaluation is warranted in situations of deteriorating health status such as Increasing confusion and difficulty recognizing people or places. Worsening headache, nausea, vomiting and excessive drowsiness or lethargy. Upon medical evaluation, we recommend booking an initial assessment with a SHIFT Concussion Certified practitioner. Even if you do not have an imPACT baseline assessment, we will assess your injury and provide you with a management strategy to aid in your recovery. Assessments and subsequent therapy/visits are covered under most extended healthcare benefits (eg. Osteopathy, Athletic Therapy, Physiotherapy). For inquiries about appointments and fees, please contact us at 905-848-3010 or appt_reminder@SportsTherapyCAiRE.com

Concussion Assessment - What to expect.

We conduct a thorough post-injury evaluation in order to gain a complete picture of your injury. Describe the mechanism of injury History of signs and symptoms History of previous concussions Current and past medical conditions Previous trauma/injury Medications The physical examination provides us with insight into the severity of your injury, as well as specific impairments that may need to be addressed as part of an ongoing management strategy. This portion of testing may include a combination of the following Computerized neurocognitive testing Balance testing Strength and coordination testing Screening of visual motor skills Vestibular (or equilibrium) testing Gait assessment Neurological cranial nerve screen Orthopedic assessment of secondary injuries (e.g. neck, shoulders) The above testing procedures may not all be completed on the first visit. The assessment method is tailored to the immediate needs of the athlete and each Healthcare Provider uses his/her discretion on a case-by-case basis.

TREATMENT STRATEGIES

Following a concussion, the “sitting in a dark room” approach is only effective for so long. Concussions, like other sports injuries should be properly managed and rehabilitated. While complete physical and cognitive rest is the mainstay of concussion care, having a health professional guide you through this step-by-step may prove to be invaluable. At SPORTS THERAPY C.A.i.R.E. we understand that each person is affected differently and therefore requires individualized care. Recovering strategies include any combination of the following and are case-dependent

• Individualized resting strategies and home instruction
• Specific recommendations with employment / academic demands
• Osteopathic Manual Therapy for associated complaints (cranial therapy, headaches, neck pain, whiplash etc.)
• Visual motor rehabilitation
• Vestibular therapy
• Physical exertion testing and exercise protocols for return-to-sport

Once symptom free, a graduated process of physical exertion testing is prescribed. Recovery from a concussion should be gradual with specific return-to-play-work-school exertion protocols. Physical exertion testing is important not only for physical re-conditioning, but also to prevent symptom relapse and premature return-to-sport. Our Team of Concussion Athletic injury Rehab Exercise practitioners will guide you through this process.

CONCUSSION FAQs.

The working definition today for concussion is “a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces” (developed by the consensus panel at the 1st International Conference on Concussion in Sport that was held in Vienna, Austria in 2001). Put simply, a concussion changes the way our brain functions – causes it to work less optimally. It may be caused either by a direct blow to the head, face, neck or elsewhere on the body with an “impulsive” force transmitted to the head. A Concussion may or may not involve loss of consciousness. In fact, less than 20% of concussions result in a loss of consciousness.

Symptoms of Concussion Syndrome

• Headache and Dizziness
• Neck pain, nausea or vomiting
• Loss of balance and coordination
• Difficulty focusing, reading words
• Poor concentration and Feeling “foggy”
• Confusion, amnesia and poor memory
• Blurred, Ddouble vision or seeing “stars”
• Irritability or emotional changes
• Ringing in ears, Tinnitus
• Decreased playing ability
• Easily distracted and attention deficit
• Vacant stare, drowsiness, fatigue, lethargy
• Difficulty falling asleep

What happens to the brain during a concussion? A direct or indirect blow to the head, face or jaw can cause the brain to accelerate then rapidly decelerate within the skull. This acceleration/deceleration motion can induce mechanical changes to the nerve fibres – causing them to stretch – and in turn, alter several important metabolic pathways. Though injury is apparent given the spectrum of symptoms experienced by a concussed athlete, no structural damage is caused to the brain itself. That is, unlike other sports injuries (like a fractured wrist or dislocated shoulder) nothing appears abnormal on standard imaging studies like CT, or MRI. Instead, these imaging methods are used to rule out more severe trauma such as bleeding within the brain or skull or fractures of the skull or neck. We understand now, more than ever, that just because we can’t see the injury, it doesn’t mean that something’s not wrong. Current evidence suggests that the rapid stretch of nerve fibres within the brain during a concussive trauma results in the release of various neurotransmitters (signalling molecules within the brain), which trigger the initiation of a complex neurometabolic pathway. Ultimately an energy crisis ensues, and the brain is unable to produce the energy required to sustain its normal processes. These changes take place within minutes of the injury and can last for hours or days before normalization occurs.It is thought to be this metabolic imbalance, along with other impaired physiological processes that contribute to the physical, cognitive, behavioural and emotional signs and symptoms typically seen in a concussed individual.

What is the recovery timeframe after a concussion? The majority of concussion-related symptoms are thought to resolve in a short timeframe (days to weeks); however symptoms may persist for months. Read Adam Estoclet's story.

Why some athletes seem to recover quickly and others do not remains unclear. Even when symptoms resolve quickly it is advisable that a proper gradual return-to-play protocol be carried out. The whole recovery process therefore may take upwards of 3-4 weeks (at minimum) to prevent premature return to sport. Postconcussion syndrome is a diagnostic term used when symptoms persist for several weeks and sometimes months after the injury. If your symptoms persist beyond 3-4 weeks it is important that you undergo proper medical assessment and management strategies for your condition.

What is “secondary impact syndrome”? Second Impact Syndrome is a rare, but serious consequence of head trauma which results in rapid swelling of the brain – potentially leading to severe disability or death. Controversy exists as to whether second impact syndrome is a product of cumulative head trauma (when an athlete sustains a concussion while still suffering the effects of a previous concussion), or if it is simply a product of a single, mild traumatic brain injury. Regardless of its cause, second impact syndrome is a severe consequence of head injury in young athletes. Absolutely NO return to play while an athlete is displaying signs and symptoms of a concussion, regardless of the level of competition.

Once I’ve had a concussion, is it easier to sustain another? When the brain is in a state of metabolic dysfunction (such as with a concussion) it is believed to be more “vulnerable” to subsequent trauma. That is, a relatively minor second blow to the head may produce more severe and irreversible changes in brain function. The physiologically altered brain is essentially weakened and less able to withstand or recover from a subsequent mild concussion. Concussive injuries are thought to be cumulative, with progressively less force required to induce trauma to the brain each time. The symptoms experienced may be completely disproportionate to the mechanism of injury. What would have been two “mild” head injuries summate to form a more severe traumatic brain injury with longer lasting impairment. Athletes often minimize the severity of concussion-like symptoms, or do not report symptoms at all following head injury. This may be because the athlete wants to continue playing and believes the symptoms are mild enough to play through. The athlete may believe having their “bell rung” is part of the game. In these situations, often the athlete, parent, coach, or trainer does not realize the significant consequences of playing with a concussion.

How do I know if my son/daughter or player has sustained a concussion? Concussions can be difficult recognize if symptoms are not reported. Often signs of dehydration and heat-related illness may give the appearance of concussive symptoms. As a rule of thumb to athletes, parents, or coaches; when an athlete has sustained the mechanism of a head injury, it must be treated as a concussion. The mechanism of injury may be subtle and not necessarily the classic “big hit.” An athlete that is behaving abnormal, difficulty remembering plays or following instructions may have sustained an injury several hours previously. Absolutely NO return to play; initiate early management protocols regardless of athletic performance. Parents, coaches, and trainers should be taught a symptom scale/checklist method for identifying a potential concussion. The Pocket Concussion Recognition Tool is a valuable sideline assessment tool that can be used to evaluate coordination, vision and memory, however it is not designed to replace a comprehensive evaluation by a medical professional.

Once symptom free, how does the return-to-play process work? Once symptom free, it is recommended that each athlete undergo a graduated program of exercise testing. Similar to weight training, athletes recovering from a concussion should not skip to 100% exertion from 0% in a short time frame. Physical exertion testing is important not only for physical re-conditioning, but to guard against symptom relapse and help prevent premature return-to-sport. It is well known that concussive symptoms can be aggravated with exercise and even though you may feel well, running, jumping, or stick handling are things that may cause your symptoms return.

The return-to-play process is gradual. The first stage typically involves light cycling or jogging to elevate your heart rate a moderate amount. If no symptoms are aggravated either during or for 24 hours after this exercise session, you may progress to a more difficult workout routine. Eventually you may advance to on-field or on-ice practice and finally full game play (with proper medical clearance). The whole process could take anywhere from 5 days to 2 weeks depending on your specific situation or the stipulations of your governing sport organization. At any time if your symptoms return, you must return to a lower level exertion (or modified activities) depending on the advice of your health professional.

I think I may have a Concussion. What should I do?

STEP 1 Make sure that you tell someone (your coach, parent, teacher etc.) so that you are not left alone. Remove yourself from sport, class, and/or work until a Medical Physician can properly assess you. Complete rest is the best treatment during the initial hours of the injury.

STEP 2 Schedule an appointment to see a Medical Physician as soon as possible. It is not usually necessary to visit the emergency room unless your symptoms are severe and/or rapidly worsening. It is not usually necessary to have someone wake you in the night – get a good night’s sleep, and nap when you need to. Limit use of your phone, television, and computer – try to rest both your body and your brain.

STEP 3 Undergo proper medical evaluation by a Physician. This does not typically include CT or MRI unless more severe injury is suspected or needs to be ruled out.

STEP 4 Visit one of the Shift Concussion Management clinics in your area for further assessment. If you have previously undergone baseline testing, repeat testing will demonstrate any areas that may be impaired due to the injury and will help guide management recommendations. If you have not previously undergone baseline testing, a follow-up assessment with one of our Health Professionals is still highly recommended.

STEP 5 Follow any management recommendations given to you by your Physician and Shift Health Professional. These may include manual therapy (eg. for associated neck pain), specific rest strategies and home recommendations, modified school and/or work requirements, specialized rehabilitative techniques (eg. vision therapy), and other recovery strategies.

STEP 6 Follow-up with the Health Professionals involved in your care so that your recovery is properly monitored. If you have questions – ask! Knowledge of your injury will aid in your recovery.